A meeting of experts convened by WHO in 2002 reviewed current knowledge on birthweight as a health outcome and identified a need for research to develop fetal growth charts for international use [11]. Growth chart for fetal head circumference. All scanning appointments were arranged at the time of the dating scan and study enrollment. A blood test checks for levels of two substances -- pregnancy-associated plasma protein-A (PAPP-A) and human chorionic gonadotropin. Congo, Democratic Republic of the Congo. The France team would like to acknowledge ultrasonographer Catherine Egoroff. However, the best time to perform elective dental treatment during pregnancy is in the second trimester, weeks 14 through 20. Female and male growth of estimated fetal weight during gestational weeks 14–40. Norway had the highest median birthweight (3,575 g), and Denmark and Germany had birthweights approximately 100 g less, while Argentina, Brazil, and France had birthweights 200 g less. Table 1 shows the numbers of women recruited, those withdrawing consent, those lost to follow-up, and those having miscarriages or intrauterine deaths, by country. Participants for whom clinical conditions occurred during pregnancy and childbirth were retained in the study. This exciting time is definitely the home stretch for expectant mothers, but itâs also a time when complications can occur. It follows that whenever the WHO growth charts, or any reference intervals, are applied to a population, their performance should be checked or tested in order to ensure appropriate use. This difference in size by fetal sex was significant at the 5% level for all percentiles. The following measurement techniques were used. Weight wearing light clothing was measured using a beam balance with nondetachable weights and recorded to the nearest 0.1 kg. The compulsory ultrasound measurements obtained at all visits included the following biometric parameters: biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL), and humerus length (HL). EFW was calculated by including HC, AC, and FL in Hadlock et al.’s third formula [24]. After the fitting, the results were retransformed to the original scale. In the same table, the level of significance is listed for these variables, e.g., p < 0.001 for country, highly significant. The models were checked by the residual analysis produced by the software. body mass index;BPD, This is the result of a tremendous global effort to achieve the UN Millennium Development Goals [1] and the goals of the UN Secretary-General’s Every Woman Every Child initiative [2]. If they're abnormal, your doctor may suggest further tests to rule out problems. ¾ First Trimester: <14 weeks ¾ Second Trimester: >14 to <28 weeks ¾ Third Trimester: >28 weeks Another recently published multinational study by the Intergrowth-21st Project presented biometric growth but not EFW data [18]. A third trimester induction abortion is performed at 25 weeks LMP (25 weeks since the first day of the womanâs last period) to term. S2 Fig. The median pregnancy duration was 39 wk (IQR 38–40) although there were significant differences between countries, the largest difference being 12 d (95% CI 8–16). We thank Mario Merialdi and George Bega for their contributions during the first stages of the study. Statistika Consultoria, São Paulo, Brazil, Affiliation Graphs of the 10th, 50th, and 90th percentiles for the ultrasound measure BPD in millimeters for the ten participating countries. Maternal weight seems to be associated with a small positive effect on EFW, especially in the higher tail of the distribution, significant at the 5% level, of the order of 1% to 1.5% for each additional 10 kg of weight of the mother (S1E Fig, without adjusting for country differences). A special ultrasound, called a nuchal translucency screening, measures the back of the baby's neck. last menstrual period;TI, Most of the countries had a similar distribution between female and male neonates except for Egypt, Germany, and Norway, where about 40% of neonates were female. Table 16 demonstrates the relation between studies for the clinically important 10th and 90th percentiles for EFW. The flexibility of the fitting and the fact that any inference drawn is entirely data-driven led us to choose quantile regression as the method for the construction of reference curves. The Germany team would like to acknowledge study nurse Gudula Hansen. Influence of country on fetal growth expressed as the ultrasound measure head circumference. AC was measured in the transverse section of the fetal abdomen that was as close as possible to circular and that included the stomach and the junction of the umbilical vein and portal sinus. Although no formal statistical comparison was undertaken, the results of these studies illustrate the distribution that can be found around the world. Secular changes in birthweight and child growth patterns have been shown to accompany social changes [42,43]. No, Is the Subject Area "Neonates" applicable to this article? It is known that body composition in Indian newborns contains relatively more fat [39], a pattern that passes across generations [40] and that is linked to increased risk of subsequent type 2 diabetes [41]. Medical Statistics Department, London School of Hygiene &Tropical Medicine, London, United Kingdom, While ethnic differences may play a role in this variation, as for the US-based study [19], variation could also be due to differences in diet and cultural and socioeconomic factors commonly associated with particular ethnic groups. Access to the web system was password protected, and only authorized users had access. The Norway team would like to acknowledge the local coordinating physician Synnøve Lian Johnsen; midwives Ine Hildershavn Moen, Guro Kyte Børsheim, and Jeanette Aasland; and dietitians Gro Trae and Hilde Mollestad Tveit. Gestational age was included in the model with polynomial terms (linear, quadratic, and cubic). Hypotheses on the overall importance of covariates were formally tested using likelihood ratio or Wald chi-square tests. Growth chart for estimated fetal weight (EFW) for male fetuses. This gives an impression of a wider spread for the 90th percentile than for the 10th. Growth chart for estimated fetal weight regardless of fetal sex. Others don't. Try not to worry if your results are abnormal. To complete a biophysical profile. All infants had an anthropometric assessment after delivery, including measurement of birthweight. Abbreviations: We excluded successively maternal conditions, fetal malformations, and neonatal conditions and assessed the fit for the global EFW percentiles. We believe that studying distribution dynamics may yield more information on the control of fetal growth. Compliance for all countries combined in each gestational age window was between 89.1% and 100%; 72% of the participants had a complete set of all the scheduled scans. Data Availability: Data are available upon request from Ms. Catherine Hamill (
[email protected]). The D. R. Congo team would like to acknowledge sonographers Luyeye M. Mandiangu Godefroid and Lokomba Bolamba Victor, site physicians Kiumbu Nzita and Modeste Luzingu Kinko Joy, study coordinator Bidashimwa Nzabonimpa Dieudonné, nurses Omba Dihandjo Betty and Matondo Lutonadio Hélène, and nutritionists Diba Tshilenge Solange and Bauma Juhudi Mamy. Graphs of the 10th, 50th, and 90th percentiles for the ultrasound measure HL in millimeters for the ten participating countries. Compliance by gestational age window as defined in the protocol is presented in S1 Table, by country and for all countries combined (“Total”). The specific details may vary slightly, but ultrasounds often follow the same process. The study confirmed the biologically interesting facts that fetal sex and maternal height, weight, parity, and age significantly influence fetal growth [31,36,37]. No, Is the Subject Area "Egypt" applicable to this article? This variation due to country was adjusted for maternal characteristics (mother’s age, parity, height, and weight, or with BMI substituting the latter two) and sex of the fetus. Department of Clinical Science, University of Bergen, Bergen, Norway, Affiliations Median daily caloric intake in the study group was 1,848 calories according to the 24-h dietary recall assessment, with Thailand having the lowest median, 1,232 calories, and Egypt having the highest median, 2,094 calories. Gestational age at birth varied between countries from a median of 38 wk 4 d in India to 40 wk 3 d in Norway (p < 0.001 for differences among countries) (Table 3). The Bowley coefficient of asymmetry [29], based on differences of semi-quartile ranges relative to the quartile range, was −0.016 for gestational age 15 wk and +0.111 for 40 wk. Growth chart for fetal femur length/head circumference ratio. Thirty-one women had a miscarriage, and three fetuses had intrauterine death. Mosby: 2010. Advances brought by computer power and by the work of Koenker and others have made it possible to estimate the distributions directly by estimating their quantiles. The percentiles (percent) 1st, 5th, 10th, 50th, 90th, 95th, and 99th (smoothed lines) are based on quantile regression and are shown with the observed values (grey dots). David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, United States of America, A total of 7,924 sets of ultrasound measurements were analyzed by quantile regression to establish longitudinal reference intervals for fetal head circumference, biparietal diameter, humerus length, abdominal circumference, femur length and its ratio with head circumference and with biparietal diameter, and EFW. All rights reserved. The median TI was 0.2, and none had TI ≥ 1.0. It is possible to adjust them by changing cutoffs (e.g., from 10th to 5th percentile) to fit clinical needs better, and it is possible to customize the percentiles to country, maternal characteristics, and fetal sex to improve diagnostic performance [45]. Participants had anthropometric and nutritional assessments and seven scheduled ultrasound examinations during pregnancy. Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt, Affiliation (2017) The World Health Organization Fetal Growth Charts: A Multinational Longitudinal Study of Ultrasound Biometric Measurements and Estimated Fetal Weight. At 25 weeks, a baby is almost fully-developed and is considered viable, meaning he or she could survive outside the womb. Variation in fetal growth within and between populations should therefore not be ignored. The long-term effects of repeated ultrasound exposures on the fetus are not fully known. 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